Objective The aims of this study were to compare the clinical and laboratory responses to ursodeoxycholic acid (UDCA) monotherapy with the combination therapy of UDCA plus prednisolone/azathioprine in primary biliary cirrhosis(PBC),and to investigate the risk factors affecting the therapeutic responses.Methods Eighty-two patients with untreated PBC were divided randomly into three groups.Group U (28 patients) received UDCA alone,group UP(27 patients) received UDCA and pr ednisolone,while group UA (27 patients ) received UDCA and azathioprine.The clinical and laboratory data were recorded after treated for 3,6 and 12 months.Repeated measures ANOVA and COX regression model were used for statistical analysis.Results Fatigue and pruritus were improved only in group UP(P=0.015 and P=0.037 respectively).Alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),gamma-glutamyl transferase (GGT),total bilirubin (TBIL),direct bilirubin (DBIL) and IgM in the 3 groups were decreased (P＜0.05),while there was no statistical significant difference between the three groups (P＞0.05).The patients with disease progression had higher Mayo risk score (MRS) (P=0.018) and prolonged prothrombin time (PT)(P=0.042).In group UP,side-effect associated with glucocorticosteroids occurred in eight patients while there was no side-effect in group U.High baseline levels of ALP、GGT and CHO were risk factors for biochemical remission(P=0.015).The increase of DBIL,TBIL,total bile acid(TBA) and PT did not contribute to the prediction of biochemical remission ( P=0.075 ).Conclusion There are no differences among the three groups in the improvement of hepatic biochemical data and IgM.The combination therapy of UDCA with prednisolone could relieve fatigue and itching.The disease of patients with higher Mayo risk score and prolonged PT tend to progress.High baseline levels of ALP,GGT and CHO are risk factors for biochemical remission.High baseline levels of TBIL,DBIL,TBA and PT could not predict biochemical remission.The incidence of adverse effect is lowest when treated with UDCA alone.

Antiviral Agents ; therapeutic use ; Hepatitis C ; drug therapy ; Humans ; Liver Cirrhosis ; drug therapy ; virology

Objective To evaluate the efficacy and safety of tiotropium bromide in treating stable mild and moderate chronic obstructive pulmonary diseases. Methods A randomized,double-blind,parallel comparison clinical trial was conducted in 40 patients with COPD. Twenty patients in tiotropium bromide group were treated by tiotropium bromide powder,and another twenty patients in controll group were given ipratropium,in contrast. The spirometry of both groups was conducted. 4 weeks after treatment. Results The forced expiratory volume in one second ( FEV1 ) and forced vital capacity(FVC) in two groups were significantly increased after treatment( P<0.01 ). The increase of FEV1 in tiotropium bromide group was higher than that in controll group after 4-week. There was no significant differ-ence in rescue medication consumptions. The incidence of adverse effects has no statistical difference between two groups. Conclusion Tiotropium bromide is an effective and safe bronchodilator in treating patients with COPD.

OBJECTIVE:To investigate the effects of different doses of sufentanil citrate on hemodynamic indexes and stress response indexes of Crouzon syndrome children with craniofacial reconstruction. METHODS:60 cases of Crouzon syndrome under-going craniofacial reconstruction were selected from our hospital during Jan. 2010-Jan. 2016,and then randomly divided into group A,group B and group C,with 20 cases in each group. 3 groups were given pump injection of Propofol injection 4-8 mg/(kg·h)for anesthesia induction+Sufentanil citrate injection [group A 0.3 μg/(kg·h),pump injection;group B 0.6 μg/(kg·h),pump injection;group C 1.0 μg/kg,iv,0.5 h/time] for anesthesia maintenance, Cisatracurium besilate for injection 0.1 mg/kg,iv,every 40 min, drug withdrawal 5 min before the end of surgery. The hemodynamic indexes(MAP,HR)and stress response indexes(ACTH,cor-tisol)were observed in 3 groups at different time points as well as the occurrence of ADR. RESULTS:MAP levels of group C at 5 min after skin incision,1 h after operation and immediately at the end of surgery were significantly higher than before anesthesia, while those of group B were significantly higher than group C at same time points. HR of group A at 1 h after surgery and that of group B at 5 min after skin incision and 1 h after surgery were significantly higher than before anesthesias;HR of group B at 1 h after surgery was significantly lower than that of group A,and its HR at 5 min after skin incision and 1 h after surgery were signifi-cantly lower than those of group C. ACTH levels of 3 groups at 5 min after skin incision,1 h after surgery and immediately after the end of surgery were significantly higher than before anesthesia. ACTH levels of group B at 5 min after skin incision,1 h after surgery and immediately after the end of surgery were significantly lower than those of group A and C,and the group A was signifi-cantly lower than the group C at same time points. Cortisol levels of group A at 1 h after surgery,and those of group C at 5 min af-ter skin incision,1 h after surgery and immediately after the end of surgery were significantly higher than before anesthesia. Corti-sol levels of group B at 1 h after surgery were significantly lower than those of group A;cortisol levels of group A at 5 min after skin incision and immediately after the end of surgery and those of group B at 5 min after skin incision,1 h after surgery and imme-diately after the end of surgery were all significantly lower than those of group C. There were statistical significance all above(P<0.05). No obvious ADR was found in 3 groups. CONCLU-SIONS:Pump injection of sufentanil citrate 0.6 μg/(kg·h) can maintain analgesic effect of Crouzon syndrome children with craniofacial reconstruction,can keep hemodynamics sta-ble and effectively inhibit stress response during surgery with good safety.

Objective To investigate the role of self-made auxiliary device in pelvic tumor radiotherapy with phantom immobilization using Varian cone-beam CT (CBCT).Methods A total of 50 patients with pelvic tumor were enrolled and randomly divided into study group and control group according to the order of enrollment.The patients in the study group were immobilized with thermoplastic phantom and self-made auxiliary device,and those in the control group were immobilized with thermoplastic phantom.CBCT scan and online matching were regularly performed before radiotherapy to obtain the setup errors of the left-right (x),cranial-caudal (y),and anterior-posterior (z) directions.The independent-samples t-test was used for comparison between groups.Results The set-up errors in the x-,y-,and z-directions in the study group were 1.56± 1.00 mm,1.60± 1.29 mm,and 1.36± 1.00 mm,respectively,and those in the control group were 1.76±1.33 mm,2.76±1.69 mm,and 1.92±0.91 mm,respectively (P=0.551,0.009,and 0.043).Conclusions Self-made auxiliary device helps to eliminate the errors in the cranial-caudal direction and solve the problem of involuntary activities of the lower limbs.

Objective Clinicians are very cautious on operationsof laparoscopic cholecystectomy(LC) in patients with cirrhosis because of its high risk.And few researches were carried out on this situation.This article aimed to summarize the LC in cirrhotic patients with cholecystolithiasis and cholecystitis, observe the clinical therapeutic effect and analyze the feasibility of this treatment.Methods The clinical data of 112 operation cases of cholecystolithiasis and cholecystitiswith cirrhosis were retrospectively analyzed from January 2012 to December 2015 in Department of General Surgery, Changzhou Third People's Hospital.According to different surgical methods, all patients were divided into laparoscopic cholecystectomy group (n=56) and open cholecystectomy group (n=56).Peroperative period indicators including operation time, intraoperative blood loss, Postoperative exhaust time, postoperative hospital stay and complications were recorded, data were analyzed to evaluate the clinical effect.Results Compared with open cholecystectomy group, laparoscopic cholecystectomy group had shorter operative time[(54.28±15.34)min vs (91.63±20.09)min,P=0.000];less intraoperative blood loss[(73.42±4.28)mL vs (98.54±7.16)mL,P=0.000], shorter Postoperative exhaust time and postoperative hospital stay(P=0.000).The complication incidence in laparoscopic cholecystectomy group were lower than that in open cholecystectomy group(7.14% vs 21.43%, P<0.05).Conclusion Operation of laparoscopic cholecystectomy on cirrhotic patients has a high clinical efficacy.It is safe and feasible to carry out such an operation on the basis of strict indication and reasonable risk assessment.

ObjectiveTo observe the effect of enema with Chinese medicine Changduqing combined with plasma exchange for treatment of endotoxemia in patients with acute-on-chronic liver failure.Methods A prospective randomized controlled trial was conducted, and 68 patients with acute-on-chronic hepatic failure who were hospitalized from January 2009 to June 2012 in the First Affiliated Hospital of Henan University of Traditional Chinese Medicine were randomly divided into treatment and control groups, 34 cases in each group. The patients in control group were treated with plasma exchange combined with western medicine comprehensive treatment such as protecting liver, reducing enzyme, removing jaundice, and in cases with hepatitis B, antiviral therapy was added. The treatment in patients of treatment group was the same as that in the control group, but additionally Changduqing enema of TCM decoction was given(ingredients: radix et rhizoma ginseng 10 g, flos magnolia officinalis 6 g, radix et rhizoma rhei 6 g, fructus aurantii immaturus 6 g, radix paeoniae rubra 10 g),twice a day combined with 3-4 times of plasma exchange treatment, once every 72 hours. The course of treatment of both groups was 4 weeks. The changes of total bilirubin (TBil), alanine aminotransferase(ALT), albumin(ALB), prothrombin activity(PTA), endotoxin, the improvement of clinical symptoms and signs such as lacking in strength, poor appetite, abdominal distension, oliguria, bleeding tendency, hepatic encephalopathy, infection and ascites were observed before and after treatment, and the survival rate in 24 weeks of follow-up was also investigated.Results Before treatment, the comparisons of TBil,ALT, ALB and PTA between the two groups were of no statistically significant differences(allP>0.05); compared with those before treatment, the levels of TBil and ALT were obviously decreased, and PTA was markedly increased after treatment in both groups, the degree of change being more prominent in treatment group〔TBil(μmol/L): 89.6±52.3 vs. 124.6±64.4, ALT(U/L):52.4±32.1 vs. 98.3±42.5, PTA:(53.8±11.5)% vs.(41.2±10.2)%, allP<0.05〕. The ALB levelsbefore and after treatment of both groups showed no significant difference(bothP>0.05). After treatment, the endotoxin(kU/L) in both groups were decreased in inchoate, developing and fully-developed stages and the descent being more significant in treatment group(inchoate stage: 0.094±0.015 vs. 0.109±0.032, developingstage: 0.102±0.019 vs. 0.146±0.062, fully-developed stage: 0.124±0.022 vs. 0.196±0.074, allP<0.05). The 24-week survival rates of developing and fully-developed stages in patients of both groups were lower than the rate in patients of inchoate stage, and the rates of treatment group in inchoate and developing stages were remarkably higher than the rate in control group〔inchoate stage: 94.1%(16/17) vs. 83.3%(15/18), developed stage: 85.7%(12/14) vs. 42.9%(6/14),bothP<0.01〕.ConclusionEnema with TCM Changduqing combined with plasma exchange for treatment of patients with acute-on-chronic liver failure can remove bilirubin, ameliorate endotoxemia, elevate PTA level and increase the survival rate of patients in 24 weeks of follow-up.

OBJECTIVETo compare the effects between plum-blossom needle tapping at Jiaji (EX-B 2) combined with rehabilitation and simple rehabilitation for ataxia of cerebellar apoplexy.

METHODSSixty patients with ataxia of cerebellar apoplexy were randomly divided into an observation group,and a control group,30 cases in each one. Conventional rehabilitation training was applied in the control group. While based on the treatment as that of the control group, plum-blossom needle tapping at Jiaji (EX-B 2) was used in the observation group. All the treatment was given for 4 weeks. International cooperative ataxia rating scale (ICARS), Berg balance scale (BBS) and Barthel index (BD were observed before treatment,after 2-week treatment and 4-week treatment. Also, clinical effects After treating for 2 weeks and for 4 weeks, the results of ICARS,BBS and BI were obvi were compared.

RESULTSAfter treating for 2 weeksand for 4 weeks, the results of ICARS, BBS and BI were obviously better than those before treatment in the two groups (all P<0.05). After 2-week treatment,there was no sta tistical significance between the two groups (all P>0. 05). After 4-week treatment,all the scores of the observation group were apparently superior to those of the control group (all P<0. 05). The total effective rate was 96. 7% (29/30) in the observation group, better than 80. 0% (24/30) in the control group after 4-week treatment (P<0. 05). CCONCLUSION:Plum-blossom needle tapping at Jiaji(EX-B 2) combined with rehabilitation training markedly improve the coordination and balance functions and activities of daily life, which are better than simple rehabilitation.

Acupuncture Points ; Acupuncture Therapy ; methods ; Aged ; Ataxia ; etiology ; rehabilitation ; therapy ; Combined Modality Therapy ; Female ; Humans ; Male ; Middle Aged ; Needles ; Stroke ; complications ; Treatment Outcome

OBJECTIVETo evaluate the efficacy on hemiplegic spasticity after cerebral infarction treated with plum blossom needle tapping therapy at the key points and Bobath therapy.

METHODSEighty patients were collected, in compliance with the inclusive criteria of hemiplegic spasticity after cerebral infarction, and randomized into an observation group and a control group, 40 cases in each one. In the control group, Bobath manipulation therapy was adopted to relieve spasticity and the treatment of 8 weeks was required. In the observation group, on the basis of the treatment as the control group, the tapping therapy with plum blossom needle was applied to the key points, named Jianyu (LI 15), Jianliao (LI 14), Jianzhen (SI 9), Hegu (LI 4), Chengfu (BL 36), Zusanli (ST 36), Xiyangguan (GB 33), etc. The treatment was given for 15 min each time, once a day. Before treatment, after 4 and 8 weeks of treatment, the Fugl-Meyer assessment (FMA) and Barthel index (BI) were adopted to evaluate the motor function of the extremity and the activity of daily life in the patients of the two groups separately. The modified Ashworth scale was used to evaluate the effect of anti-spasticity.

RESULTSIn 4 and 8 weeks of treatment, FMA: scores and BI scores were all significantly increased as compared with those before treatment in the two groups: (both P<0. 05). The results in 8 weeks of treatment in the observation group were significantly better than those in the control group (all P<0. 05). In 4 and 8 weeks of treatment, the scores of spasticity state were improved as compared with those before treatment in the patients of the two groups (all P<0. 05). The result in 8 weeks of treatment in the observation group was significantly better than that in the control group (P<0. 05). In 8 weeks of treatment, the total effective rate of anti-spasticity was 90. 0% (36/40) in the observation group, better than 75. 0% (30/40) in the control group (P<0. 05).

CONCLUSIONThe tapping therapy with plum blossom needle at the key points combined with Bobath therapy effectively relieves hemiplegic spasticity in the patients of cerebral infarction and improves the motor function of extremity and the activity of daily life.

Acupuncture Points ; Acupuncture Therapy ; instrumentation ; Aged ; Cerebral Infarction ; complications ; physiopathology ; Combined Modality Therapy ; Female ; Humans ; Male ; Middle Aged ; Muscle Spasticity ; etiology ; physiopathology ; rehabilitation ; therapy ; Treatment Outcome

Objective To evaluate the application of contrast-enhanced transrectal ultrasound ( CETRUS) to identify prostate cancer(PCa) from benign prostatic hyperplasia(BPH). Methods A total of 86 patients with focal prostatic disease detected by trans rectal ultrasound(TRUS) were enrolled in this study.Each patient underwent grey-scale TRUS, CE-TRUS, and targeted-biopsy of prostateunder ultrasound guidance successively on the same day. The criteria of perfusion pattern would be statistically analyzed among groups divided by pathological findings. Every patient's images of CE-TRUS were observed and features of perfusion pattern were recorded by two doctors who were blind to any clinical data of patient.Then these features recorded by two doctors were compared, if the features were coherent, they would be recorded as final results,and otherwise two doctors would consult till the features were coherent. Results Compared with BPH group, the enhancement features of PCa group were rapid enhancement, increased enhancement, heterogeneous enhancement, well-defined boundary of lesion after enhancement, asymmetric appearance of intraprostatic vessels, rapid decrease, perfusion defect areas within lesions and the roughly discontinuous juncture between enhancement and no enhancement area within lesions. Conclusions There was significant difference in enhancement pattern between BPH and PCa groups, observing enhancement pattern could help to identify prostate cancer from benign prostate hyperplasia.